Tubal ectopic pregnancy
Central abdominal pain since previous night, tenderness is present. Lactate is 4.0 ?Mesenteric ischaemia.
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Large volume echogenic free fluid is present in the pelvis, particularly in the region of the right adnexae, in keeping with haemoperitoneum. There is further moderate volume anechoic free fluid in the pelvis and in the perihepatic space and Morrisons (hepatorenal) pouch.
In the right adnexae, a gestational sac is present, upto 2.1 cm in maximal dimension, with a fetal pole evident. No definite fetal heart beat identified on Doppler M-mode assessment.
The right ovary was difficult to identify, due to the large amount of adjacent haemoperitoneum. The left ovary was also not well seen.
The uterus is anteverted, with a small amount of echogenic fluid/blood in the endometrial cavity. The uterus was difficult to fully characterise as the patient was unable to empty her bladder, but no definite intrauterine gestation was identified.
Findings are in keeping with a ruptured right adnexal, most likely tubal ectopic pregnancy, associated with moderate to massive haemoperitoneum.
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The patient was unstable and required transfusion of 4 units of blood, and proceeded to theatre where a right salpingectomy was performed.